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ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E. HAZFLTON AVENUE - STOCKTON CA 95205 - (209) 468-3420 <br />JOB ADDRESS <br />CROSS STREET KE N APN b 49 1 'Z 0 SU <br />OWNER NAME 1Z\\JF-e4,nA%b -t-ILeet>w4C, CONNE <br />P <br />OWNER ADDRESS (011 E. i NJ E' S -r - LD1>11 CA 9i T2.40 <br />CONTRACTOR ._....,_Lt V f- 0 A \4. G -F-0 E>JVjW-0Kj­MEr-)-V 6 pO.. 3 tv 1 - oll 5 - <br />CONTRACTOR ADDRESS 4,0 o A Y- 5;rr - ip L-,DDi C"\ 95'2-/o <br />CIE Gr- 21 1� 1 -10 -'L4 <br />LICENSE C-42 C-36 OTHER NuMsen <br />WATER TASLE DE"m' ft GEOGRAPHICAL INFORMATION: COOrdiftWeS X ...... ........ ..... . ... . . ..... . ..... . ....................... <br />PFK TEST BUILDING PERMIT# LANousEAPPucA'noN# A -Z10072-15 <br />NEW INsTALLAT" weEA DFS4GwW/ALTERNiiWi <br />REPLACEMENT . .......... ... .......... . . OJT -OF -SERVICE SEPTIC SYSTEM DESTRUCTION —­­­­­............. <br />INSTALLATION W1i.L SERVE: :: RESIDENCE COMMEROIAL OTHER. -_7 <br />#4 UNITS: NUMBER OF BEDROOMS: <br />NUMSEA OF EmPLOYEES: <br />0 SEPTIC TANK TYPEIMrG CAPArITY__. gal #Of`COMPARTMENTs-­'-- <br />0 GREASE TRAP Tw'rjMFG CAPACITY _ gat * OF COMPAR MENTO <br />DISTANCE TO NEAREST; ft FrNJNOATf0N ft PROPf.RTYUNE <br />L3 LIFT STATION SIZE ..................... ......... TYPE OF PUMP......_......_....-_ _._..3 PKG TX PtANT Q SANOOIL SEPARATOR (ENCLOSED SYSTEM) <br />LI LEACH LINES <br />I LEACHING CHAMBERS- . ........... <br />LENGTH OFLINES ft <br />DISTANCE TO NEAREST <br />ft FOUNDATION <br />ft PROPERTY LINE <br />Q FILTER BED <br />WwR <br />It LENGTH <br />it <br />DEPTH ff <br />DISTANCE TO NEAREST <br />WELL--- <br />ft F0i)NDATION <br />ft PROPERTY LINE fI <br />C3 MOUNDED <br />WoTm <br />ft LENGTH <br />it <br />DEPTH it <br />DISTANCE To NEAREST <br />WELL_— <br />ft I'MINDATiON __fl <br />PROPERTY LINE-- ft <br />Q SUMPS <br />WIDTH <br />ft LENGTH <br />DEPTH <br />DISTANCE To NEAREST <br />WELL_ <br />ft FOUNDATION <br />ft PROPERTY L04E <br />Q DISPOSAL PONDS WIDTH <br />ft LENGTH <br />ft <br />DEPTH <br />DISTANCE TO NEAREST <br />WELL-- <br />ft FOUNDATION <br />PROPERTY LINE.ft <br />0 SEEPAGE PITS <br />Numawl ­ " ""'. . . . .... . ..... . ..... --- <br />WIDTH <br />Tt DEPTH . ........... It <br />DqstANcz To NEAREST <br />WELL <br />ft FWNDATION <br />it PROPERTY LINE ­­­­­­­­ ft <br />I HERESY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL SE DONE IN ACCORDANCE WITH SAN JOAOUIN COUNTY ORDINANCES, <br />STATE LAWS AND RULES AND REGULATIONS Of SAN JOAOUIN COUNTY. <br />SIGNED <br />ULM <br />��� Z� 4� ICPARTNEI�14Y EQJMLY i / "i (' <br />Application Accepted By Date Area <br />Final Inspection 09te__ SPECIAL PERMIT -Appmved try <br />Character of SOLI to Depth of 3 flt%-­PWSUMP "I Character: <br />C <br />i OMMENTS /'yV <br />oo <br />iivWdj-7r,;jciW <br />Code I wo I Sif <br />Permit/ -- ---r — ­­- ------ <br />cam I Rernatecl Data Ranuest # Invoice III Permit 100 <br />42.01 ONSME. WASTMIATER TRTMNT SYSTEM PERMIT <br />W14118 <br />